Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
Department of Radiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
J Cardiovasc Magn Reson. 2021 Jun 3;23(1):67. doi: 10.1186/s12968-020-00700-5.
Patients who have unexplained giant T-wave inversions but do not meet criteria for hypertrophic cardiomyopathy (HCM) (left ventricular (LV) wall thickness < 1.5 cm) demonstrate LV apical morphological features that differ from healthy subjects. Currently, it remains unknown how the abnormal LV apical morphology in this patient population changes over time. The purpose of this study was to investigate LV morphological and functional changes in these patients using a mid-term cardiovascular magnetic resonance (CMR) exam.
Seventy-one patients with unexplained giant T-wave inversion who did not fulfill HCM criteria were studied. The mean interval time of the follow-up CMR was 24.4 ± 8.3 months. The LV wall thickness was measured in each LV segment according to the American Heart Association 17-segmented model. The apical angle (ApA) was also measured. A receiver operating curve (ROC) was used to identify the predictive values of the CMR variables.
Of 71 patients, 16 (22.5%) progressed to typical apical HCM, while 55 (77.5%) did not progress to HCM criteria. The mean apical wall thickness was significantly different between the two groups at both baseline and follow-up, with the apical HCM group having greater wall thickness at both time points (all p < 0.001). There was a significant difference between the two groups in the change of ApA (- 1.5 ± 2.7°/yr vs. - 0.7 ± 2.0°/yr, p < 0.001) over time. The combination of mean apical wall thickness and ApA proved to be the best predictor for fulfilling criteria for apical HCM with a threshold value of 8.1 mm and 90° (sensitivity 93.8%, specificity 85.5%).
CMR metrics identify predictors for progression to HCM in patients with unexplained giant T-wave inversion.
不明原因的巨大 T 波倒置但不符合肥厚型心肌病（HCM）标准（左心室（LV）壁厚度 < 1.5 cm）的患者表现出与健康受试者不同的 LV 心尖形态特征。目前，尚不清楚该患者人群的异常 LV 心尖形态随时间如何变化。本研究旨在通过中期心血管磁共振（CMR）检查研究这些患者的 LV 形态和功能变化。
研究了 71 名不明原因的巨大 T 波倒置但不符合 HCM 标准的患者。随访 CMR 的平均间隔时间为 24.4 ± 8.3 个月。根据美国心脏协会 17 节段模型测量每个 LV 节段的 LV 壁厚度。还测量了心尖角度（ApA）。使用接收者操作曲线（ROC）来确定 CMR 变量的预测值。
在 71 名患者中，16 名（22.5%）进展为典型心尖 HCM，而 55 名（77.5%）未进展为 HCM 标准。两组在基线和随访时的平均心尖壁厚度均有显著差异，心尖 HCM 组在两个时间点的壁厚度均较大（均 < 0.001）。两组间 ApA 的变化有显著差异（- 1.5 ± 2.7°/yr 与- 0.7 ± 2.0°/yr，p < 0.001）。随着时间的推移，平均心尖壁厚度和 ApA 的组合被证明是预测符合心尖 HCM 标准的最佳指标，其阈值为 8.1 毫米和 90°（敏感性 93.8%，特异性 85.5%）。
CMR 指标可识别不明原因巨大 T 波倒置患者进展为 HCM 的预测指标。
